Judging Quality: Parents' perspectives of the quality of their child's hospital care

English, Christine (2017) Judging Quality: Parents' perspectives of the quality of their child's hospital care. Doctoral thesis, Northumbria University.

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Abstract

Background - UK healthcare has adopted various improvement strategies from business including using satisfaction surveys. However, the way patients form and express judgements of quality care can be more complex than customer purchases. Research in adult patient satisfaction has found capturing patient opinion challenging; however, adult service- user views continue to underpin quality care guidance across healthcare. Development of knowledge to include parental views of quality care is important to inform future guidance specific to children’s services.

Methods - This study aimed to examine how parents determined the quality of care provided when their child was hospitalised, factors influencing perceptions of care and whether these judgements changed over time. Using a grounded theory approach, data were collected through a series of in-depth interviews (22) with nine parents following their child’s hospitalisation.

Findings - The substantive grounded theory - Parenting in an alien hospital world: on guard and on behalf offers new perspectives on the complex psychosocial processes underlying parents’ quality judgements. When their child was hospitalised parents landed in an ‘alien’ world but continued to try 'to parent' (protect and advocate) their child. Parents' experiences were characterised by landing; moving from being' new parents' to 'old hands'; searching for and judging the 'clues' and facing dilemmas of how best to respond to professionals. Parents were found to use an escalating level of signals to prompt health professionals to respond to their queries and concerns Parents' personal lens altered through their transitional journey and this, together with their perception of professionals' power impacted on their chosen responses to professionals and their quality judgements. Parents held two views of care quality: ‘at the time’ and a final ‘on balance’ view. The final view recognised their own heightened emotions and reflected their current transition.

Conclusions - Ultimately parents judge hospital care as high quality when they perceived health professionals acted as their allies in their parenting roles as protectors and advocates for their child in the alien hospital world. Health professionals could improve parents' experiences and quality judgements of care by early recognition and response to their 'signalling' and by explicitly acting as parental allies.

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